Zentralblatt für Chirurgie
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Esophageal resection is still today associated with a high morbidity and mortality. Minimally invasive procedures show a significantly lower rate of such complications and therefore might also be associated with a lower surgical risk. However, publications till date contain little or no data on the extent of lymph node dissection. The aim of our study was to evaluate the morbidity and mortality rate of minimally invasive esophageal resection. ⋯ Our experience with 25 successful minimally invasive esophageal resections shows that with increasing experience and better surgical equipment, the extent of lymph node dissection does not differ from open procedure.
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The introduction of minimum surgical volumes aimed at improving the quality of care is currently the subject of controversial debate. One relevant issue is whether the data from external quality assurance can be used to predict outcomes that justify the introduction of minimum surgical volumes. ⋯ In line with reports in the literature, it can be presumed that a connection exists between outcome quality and surgical volume for TKA. However, no threshold value can be deduced on the basis of current outcome data. Debate continues as to whether the introduction of minimum surgical volumes might be economically motivated and how minimum surgical volumes might impact healthcare structures. Lastly, it is discussed whether or not diagnostic related groups (DRG) inherently lead to a concentration of services that would make the introduction of minimum surgical volumes superfluous.